| Upland Grove Medical Group | |
|
1330 San Bernardino Rd Suite B Upland CA 91786-4928 | |
| (909) 981-0608 | |
| (866) 695-1267 |
| Full Name | Upland Grove Medical Group |
|---|---|
| Speciality | Pain Medicine |
| Location | 1330 San Bernardino Rd, Upland, California |
| Authorized Official Name and Position | Gregory K. Suelzle (OWNER) |
| Authorized Official Contact | 9099810608 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Upland Grove Medical Group 1330 San Bernardino Rd Suite B Upland CA 91786-4928 Ph: (909) 981-0608 | Upland Grove Medical Group 1330 San Bernardino Rd Suite B Upland CA 91786-4928 Ph: (909) 981-0608 |
| NPI Number | 1386890044 |
|---|---|
| Provider Enumeration Date | 08/13/2008 |
| Last Update Date | 04/21/2014 |
| Medicare PECOS PAC ID | 2365598562 |
|---|---|
| Medicare Enrollment ID | O20090912000079 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386890044 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | G78385 (California) | Secondary |
| 208VP0014X | Pain Medicine - Interventional Pain Medicine | G77184 (California) | Primary |
| Provider Name | Gregory K Suelzle |
|---|---|
| Provider Type | Practitioner - Interventional Pain Management |
| Provider Identifiers | NPI Number: 1326016023 PECOS PAC ID: 2466344221 Enrollment ID: I20040326000488 |
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